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Ebo DG, Toscano A, Rihs HP, Mertens C, Sabato V, Elst J, Beyens M, Hagendorens MM, Van Houdt M, Van Gasse AL. IgE-Mediated Cannabis Allergy and Cross-Reactivity Syndromes: A Roadmap for Correct Diagnosis and Management. Curr Allergy Asthma Rep 2024; 24:407-414. [PMID: 38990404 DOI: 10.1007/s11882-024-01159-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE OF THE REVIEW With increased access and decriminalization of cannabis use, cases of IgE-dependent cannabis allergy (CA) and cross-reactivity syndromes have been increasingly reported. However, the exact prevalence of cannabis allergy and associated cross-reactive food syndromes (CAFS) remains unknown and is likely to be underestimated due to a lack of awareness and insufficient knowledge of the subject among health care professionals. Therefore, this practical roadmap aims to familiarize the reader with the early recognition and correct management of IgE-dependent cannabis-related allergies. In order to understand the mechanisms underlying these cross-reactivity syndromes and to enable personalized diagnosis and management, special attention is given to the molecular diagnosis of cannabis-related allergies. RECENT FINDINGS The predominant signs and symptoms of CA are rhinoconjunctivitis and contact urticaria/angioedema. However, CA can also present as a life-threatening condition. In addition, many patients with CA also have distinct cross-reactivity syndromes, mainly involving fruits, vegetables, nuts and cereals. At present, five allergenic components of Cannabis sativa (Can s); Can s 2 (profilin), Can s 3 (a non-specific lipid protein), Can s 4 (oxygen-evolving enhancer protein 2 oxygen), Can s 5 (the Bet v 1 homologue) and Can s 7 (thaumatin-like protein) have been characterized and indexed in the WHO International Union of Immunological Sciences (IUIS) allergen database. However, neither of them is currently readily available for diagnosis, which generally starts by testing crude extracts of native allergens. The road to a clear understanding of CA and the associated cross-reactive food syndromes (CAFS) is still long and winding, but well worth further exploration.
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Affiliation(s)
- Didier G Ebo
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95 Universiteitsplein 1, Antwerp, 2610, Belgium.
- Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium.
- Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.
| | - Alessandro Toscano
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95 Universiteitsplein 1, Antwerp, 2610, Belgium
- Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Hans-Peter Rihs
- PA-Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Ruhr-University Bochum, Bochum, Germany
| | - Christel Mertens
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95 Universiteitsplein 1, Antwerp, 2610, Belgium
- Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Vito Sabato
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95 Universiteitsplein 1, Antwerp, 2610, Belgium
- Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Jessy Elst
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95 Universiteitsplein 1, Antwerp, 2610, Belgium
- Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Michiel Beyens
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95 Universiteitsplein 1, Antwerp, 2610, Belgium
- Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Margo M Hagendorens
- Department of Paediatrics and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of and Paediatrics, Antwerp University Hospital, Antwerp, Belgium
| | - Michel Van Houdt
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp University Hospital, Campus Drie Eiken T5.95 Universiteitsplein 1, Antwerp, 2610, Belgium
- Antwerp (Belgium) and Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Athina L Van Gasse
- Department of Paediatrics and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of and Paediatrics, Antwerp University Hospital, Antwerp, Belgium
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Wąsik J, Likońska A, Kurowski M. IgE-Mediated Allergy and Asymptomatic Sensitization to Cannabis Allergens-Review of Current Knowledge and Presentation of Six Cases. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:954. [PMID: 38929571 PMCID: PMC11205784 DOI: 10.3390/medicina60060954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
Cannabis allergy is a relatively new phenomenon described in the 1970s. Its increased frequency has been observed over the last years due to the increasing therapeutic and recreational use of cannabis-based products. Sensitization possibly leading to allergy symptoms can occur not only through the smoking of cannabis, but also through ingestion, the inhalation of pollen, or direct contact. The severity of symptoms varies from benign pruritus to anaphylaxis. There is scant information available to support clinicians throughout the entire therapeutic process, starting from diagnosis and ending in treatment. In this review, we present six cases of patients in whom molecular in vitro testing revealed sensitization to cannabis extract and/or cannabis-derived nsLTP molecules (Can s 3). Based on these cases, we raise important questions regarding this topic. The article discusses current proposals and highlights the importance of further research not only on cannabis allergy but also on asymptomatic sensitization to cannabis allergens, which may be ascertained in some percentage of the population.
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Affiliation(s)
- Jakub Wąsik
- Department of Immunology and Allergy, Medical University of Lodz, 90-419 Lodz, Poland; (J.W.); (A.L.)
- Student Scientific Association, Department of Immunology and Allergy, Medical University of Lodz, 90-419 Lodz, Poland
| | - Aleksandra Likońska
- Department of Immunology and Allergy, Medical University of Lodz, 90-419 Lodz, Poland; (J.W.); (A.L.)
| | - Marcin Kurowski
- Department of Immunology and Allergy, Medical University of Lodz, 90-419 Lodz, Poland; (J.W.); (A.L.)
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3
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Loblundo C, Severa J, Peruggia GA, Black KR, Chandra S, Lata H, ElSohly M, Chapman MD, Deshpande DA, Nayak AP. Proteomics-Based Approach for Detailing the Allergenic Profile of Cannabis Chemotypes. Int J Mol Sci 2023; 24:13964. [PMID: 37762267 PMCID: PMC10531008 DOI: 10.3390/ijms241813964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 09/29/2023] Open
Abstract
Allergic sensitization to cannabis is an emerging public health concern and is difficult to clinically establish owing to lack of standardized diagnostic approaches. Attempts to develop diagnostic tools were largely hampered by the Schedule I restrictions on cannabis, which limited accessibility for research. Recently, however, hemp was removed from the classified list, and increased accessibility to hemp allows for the evaluation of its practical clinical value for allergy diagnosis. We hypothesized that the proteomic profile is preserved across different cannabis chemotypes and that hemp would be an ideal source of plant material for clinical testing. Using a proteomics-based approach, we examined whether distinct varieties of cannabis plant contain relevant allergens of cannabis. Cannabis extracts were generated from high tetrahydrocannabinol variety (Mx), high cannabidiol variety (V1-19) and mixed profile variety (B5) using a Plant Total Protein Extraction Kit. Hemp extracts were generated using other standardized methods. Protein samples were subjected to nanoscale tandem mass spectrometry. Acquired peptides sequences were examined against the Cannabis sativa database to establish protein identity. Non-specific lipid transfer protein (Can s 3) level was measured using a recently developed ELISA 2.0 assay. Proteomic analysis identified 49 distinct potential allergens in protein extracts from all chemotypes. Most importantly, clinically relevant and validated allergens, such as profilin (Can s 2), Can s 3 and Bet v 1-domain-containing protein 10 (Can s 5), were identified in all chemotypes at label-free quantification (LFP) intensities > 106. However, the oxygen evolving enhancer protein 2 (Can s 4) was not detected in any of the protein samples. Similarly, Can s 2, Can s 3 and Can s 5 peptides were also detected in hemp protein extracts. The validation of these findings using the ELISA 2.0 assay indicated that hemp extract contains 30-37 ng of Can s 3 allergen per µg of total protein. Our proteomic studies indicate that relevant cannabis allergens are consistently expressed across distinct cannabis chemotypes. Further, hemp may serve as an ideal practical substitute for clinical testing, since it expresses most allergens relevant to cannabis sensitization, including the validated major allergen Can s 3.
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Affiliation(s)
- Cali Loblundo
- Department of Medicine, Center for Translational Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; (C.L.); (J.S.); (G.A.P.); (D.A.D.)
| | - Jenna Severa
- Department of Medicine, Center for Translational Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; (C.L.); (J.S.); (G.A.P.); (D.A.D.)
| | - Gabrielle A. Peruggia
- Department of Medicine, Center for Translational Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; (C.L.); (J.S.); (G.A.P.); (D.A.D.)
| | | | - Suman Chandra
- National Center for Natural Product Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA; (S.C.); (H.L.); (M.E.)
| | - Hemant Lata
- National Center for Natural Product Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA; (S.C.); (H.L.); (M.E.)
| | - Mahmoud ElSohly
- National Center for Natural Product Research, Research Institute of Pharmaceutical Sciences, School of Pharmacy, University of Mississippi, Oxford, MS 38677, USA; (S.C.); (H.L.); (M.E.)
| | | | - Deepak A. Deshpande
- Department of Medicine, Center for Translational Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; (C.L.); (J.S.); (G.A.P.); (D.A.D.)
- Division of Pulmonary, Allergy and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Ajay P. Nayak
- Department of Medicine, Center for Translational Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; (C.L.); (J.S.); (G.A.P.); (D.A.D.)
- Division of Pulmonary, Allergy and Critical Care Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, PA 19107, USA
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4
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Toscano A, Ebo DG, Abbas K, Brucker H, Decuyper II, Naimi D, Nanda A, Nayak AP, Skypala IJ, Sussman G, Zeiger JS, Silvers WS. A review of cannabis allergy in the early days of legalization. Ann Allergy Asthma Immunol 2023; 130:288-295. [PMID: 36384984 PMCID: PMC9991982 DOI: 10.1016/j.anai.2022.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/07/2022]
Abstract
Cannabis allergy is a burgeoning field; consequently, research is still in its infancy and allergists' knowledge surrounding this topic is limited. As cannabis legalization expands across the world, it is anticipated that there will be an increase in cannabis use. Thus, we hypothesize that a concomitant rise in the incidence of allergy to this plant can be expected. Initiatives aimed at properly educating health care professionals are therefore necessary. This review presents the most up-to-date information on a broad range of topics related to cannabis allergy. Although the clinical features of cannabis allergy are becoming more well described and recognized, the tools available to make a correct diagnosis are meager and often poorly accessible. In addition, research on cannabis allergy is still taking its first steps, and new and potentially groundbreaking findings in this field are expected to occur in the next few years. Finally, although therapeutic approaches are being developed, patient and physician education regarding cannabis allergy is certainly needed.
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Affiliation(s)
- Alessandro Toscano
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Post-Graduate School of Allergology and Clinical Immunology, University of Milan, Milan, Italy.
| | - Didier G Ebo
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium; Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
| | - Khaldon Abbas
- Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Ine I Decuyper
- Department of Pediatrics and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - David Naimi
- Naval Hospital Camp Pendleton, Oceanside, California
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Dallas, Texas; Division of Allergy and Immunology, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ajay P Nayak
- Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Isabel J Skypala
- Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Gordon Sussman
- Department of Medicine and Division of Clinical Immunology & Allergy, University of Toronto, Toronto, Ontario, Canada
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5
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Toscano A, Elst J, van der Poorten ML, Beyens M, Heremans K, Decuyper II, Van Gasse AL, Mertens C, Van Houdt M, Hagendorens MM, Sabato V, Ebo DG. Establishing diagnostic strategies for cannabis allergy. Expert Rev Clin Immunol 2022; 18:1015-1022. [PMID: 35912836 DOI: 10.1080/1744666x.2022.2108791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Cannabis is the most widely consumed illicit drug in the world and carries a risk of severe IgE-mediated allergic reactions, requiring appropriate diagnostic management. Currently available diagnostics are still relatively limited and require careful interpretation of results to avoid harmful over- and underdiagnosis. AREAS COVERED This review focuses on the most up-to-date understandings of cannabis allergy diagnosis, starting with the main clinical features of the disease and the allergenic characteristics of Cannabis sativa, and then providing insights into in vivo, in vitro, and ex vivo diagnostic tests. EXPERT OPINION At present, the diagnosis of IgE-mediated cannabis allergy is based on a three-step approach that starts with accurate history taking and ends with a confirmation of sensitization to the whole extract and, finally, molecular components. Although much has been discovered since its first description in 1971, the diagnosis of cannabis allergy still has many unmet needs. The lack of commercial standardized and validated extracts and in vitro assays makes a harmonized workup of cannabis allergy difficult. Furthermore, the epidemiological characteristics, and clinical implications of sensitization to different molecular components are not yet fully known. Future research will complete the picture and likely result in an individualized and standardized approach.
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Affiliation(s)
- Alessandro Toscano
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Post-Graduate School of Allergology and Clinical Immunology, University of Milan, Milan, Italy
| | - Jessy Elst
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Marie-Line van der Poorten
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Pediatrics and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Michiel Beyens
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Kevin Heremans
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Ine I Decuyper
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Pediatrics and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Athina L Van Gasse
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Christel Mertens
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Michel Van Houdt
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium
| | - Margo M Hagendorens
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Pediatrics and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vito Sabato
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
| | - Didier G Ebo
- Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium.,Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
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Skypala IJ, Jeimy S, Brucker H, Nayak AP, Decuyper II, Bernstein JA, Connors L, Kanani A, Klimek L, Lo SCR, Murphy KR, Nanda A, Poole JA, Walusiak-Skorupa J, Sussman G, Zeiger JS, Goodman RE, Ellis AK, Silvers WS, Ebo DG. Cannabis-related allergies: An international overview and consensus recommendations. Allergy 2022; 77:2038-2052. [PMID: 35102560 PMCID: PMC9871863 DOI: 10.1111/all.15237] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/10/2022] [Accepted: 01/23/2022] [Indexed: 01/26/2023]
Abstract
Cannabis is the most widely used recreational drug in the world. Cannabis sativa and Cannabis indica have been selectively bred to develop their psychoactive properties. The increasing use in many countries has been accelerated by the COVID-19 pandemic. Cannabis can provoke both type 1 and type 4 allergic reactions. Officially recognized allergens include a pathogenesis-related class 10 allergen, profilin, and a nonspecific lipid transfer protein. Other allergens may also be relevant, and recognition of allergens may vary between countries and continents. Cannabis also has the potential to provoke allergic cross-reactions to plant foods. Since cannabis is an illegal substance in many countries, research has been hampered, leading to challenges in diagnosis since no commercial extracts are available for testing. Even in countries such as Canada, where cannabis is legalized, diagnosis may rely solely on the purchase of cannabis for prick-to-prick skin tests. Management consists of avoidance, with legal issues hindering the development of other treatments such as immunotherapy. Education of healthcare professionals is similarly lacking. This review aimed to summarize the current status of cannabis allergy and proposes recommendations for the future management of this global issue.
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Affiliation(s)
- Isabel J. Skypala
- Department of Allergy & Clinical Immunology, Royal Brompton & Harefield Hospitals, and Imperial College, London, UK
| | - Samira Jeimy
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, Ontario, Canada
| | | | - Ajay P. Nayak
- Center for Translational Medicine and Division of Pulmonary Allergy and Critical Care Medicine, Department of Medicine, Jane and Leonard Korman Respiratory Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ine I. Decuyper
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University Hospital of Antwerp, University of Antwerp, Antwerp, Belgium
| | - Jonathan A. Bernstein
- Division of Immunology/Allergy Section, Department of Internal Medicine, University of Cincinnati College of Medicine and Bernstein Allergy Group; Bernstein Clinical Research Center, Cincinnati, Ohio, USA
| | - Lori Connors
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amin Kanani
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ludger Klimek
- Center for Rhinology and Allergy, Wiesbaden, Germany
| | - Shun Chi Ryan Lo
- Division of Allergy and Immunology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin R. Murphy
- Division of Allergy, Asthma and Pediatric Pulmonology, Department of Pediatrics, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | - Anil Nanda
- Asthma and Allergy Center, Lewisville and Flower Mound, Dallas, Texas, USA,Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jill. A. Poole
- Division of Allergy and Immunology, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Jolanta Walusiak-Skorupa
- Department of Occupational Medicine and Environmental Health, Nofer Institute of Occupational Medicine, Lodz, Poland
| | - Gordon Sussman
- Department of Medicine and Division of Clinical Immunology & Allergy, University of Toronto, Toronto, Ontario, Canada
| | | | - Richard E. Goodman
- Food Allergy Research and Resource Program, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Anne K. Ellis
- Division of Allergy & Immunology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - William S. Silvers
- Division of Allergy Clinical Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Didier G. Ebo
- Faculty of Medicine and Health Sciences, Department of Immunology, Allergology, Rheumatology and the Infla-Med Centre of Excellence, University of Antwerp, Antwerp, Belgium,Department of Immunology, Allergology, Rheumatology, Antwerp University Hospital, Antwerp, Belgium,Department of Immunology and Allergology, AZ Jan Palfijn Gent, Ghent, Belgium
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7
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Tambuzzi S, Gentile G, Boracchi M, Di Candia D, Bianchi R, Zoja R. Postmortem diagnostics of assumed suicidal food anaphylaxis in prison: a unique case of anaphylactic death due to peach ingestion. Forensic Sci Med Pathol 2021; 17:449-455. [PMID: 33939114 PMCID: PMC8413180 DOI: 10.1007/s12024-021-00373-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2021] [Indexed: 02/02/2023]
Abstract
Suicidal ingestion of food which the victim is aware they are allergic to is an exceptional occurrence in the forensic field. To the best of our knowledge, no cases of suicidal food anaphylaxis have been reported to date. Therefore we present the first case described in the literature. A 30-year-old prisoner was found dead inside his cell with the remains of a peach remains next to his body, and a handwritten farewell note in his pocket. The autopsy revealed only non-specific findings, while laboratory investigations (serological, toxicological, histological, and immunohistochemical) played a pivotal role in determing the cause and manner of death. In particular, a high titer of both total and specific IgE antibodies was detected, as well as an increase of the tryptase level in cadaveric blood. Moreover, a massive concentration of salicylates was measured in the gastric contents. Microscopically, cellular residues characterized by a vegetal structure were observed in the gastric contents and elements suggestive of mast cells were detected in the glottis, lungs, and myocardium. The immunohistochemical investigation with anti-CD117 and anti-tryptase antibodies showed positivity for mast cells, some of which appeared degranulated. Such findings were entirely consistent with an acute systemic anaphylactic reaction triggered by allergy. Therefore, the prisoner’s death was attributed to self-induced food anaphylaxis caused by the ingestion of peaches. This conclusion was achieved based only on circumstantial data, anamnestic information, autopsy findings, and multiple laboratory results. This integrated approach should be used to pursue a post-mortem diagnosis of anaphylaxis.
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Affiliation(s)
- Stefano Tambuzzi
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37 - 20133, Milano, Italy
| | - Guendalina Gentile
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37 - 20133, Milano, Italy
| | - Michele Boracchi
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37 - 20133, Milano, Italy
| | - Domenico Di Candia
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37 - 20133, Milano, Italy
| | - Rachele Bianchi
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37 - 20133, Milano, Italy
| | - Riccardo Zoja
- Dipartimento di Scienze Biomediche per la Salute, Sezione di Medicina Legale e delle Assicurazioni, Università degli Studi di Milano, Via Luigi Mangiagalli, 37 - 20133, Milano, Italy.
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Jackson B, Cleto E, Jeimy S. An emerging allergen: Cannabis sativa allergy in a climate of recent legalization. Allergy Asthma Clin Immunol 2020; 16:53. [PMID: 32834822 PMCID: PMC7371810 DOI: 10.1186/s13223-020-00447-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/04/2020] [Indexed: 11/13/2022] Open
Abstract
Considering its recent legalization in Canada, the health implications of Cannabis sativa exposure, including allergy, are coming to the forefront of medical study and interest. C. sativa allergy is an issue that affects recreational users of the substance, processors, agricultural workers, and contacts of Cannabis aeroallergens and secondhand product. Allergies to C. sativa are heterogenous and span the spectrum of hypersensitivity, from dermatitis to rhinoconjunctivitis to life-threatening anaphylaxis. Due to its recent legalization, sensitized individuals will have increasing exposure from direct contact to agricultural pollens. Diagnosis and treatment of Cannabis allergy are developing fields that are already showing promise in the identification of culprit antigens and the potential for immunotherapy; however, much responsibility still falls on clinical diagnosis and symptom management. Hopefully, given the current explosion of interest in and use of Cannabis, C. sativa allergy will continue to garner awareness and therapeutic strategies.
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Affiliation(s)
- Bradley Jackson
- Department of Paediatrics, Children's Hospital, London Health Sciences Centre, London, ON Canada
| | - Erica Cleto
- Schulich School of Medicine and Dentistry, Western University, London, ON Canada
| | - Samira Jeimy
- Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON Canada.,B3-112, St. Joseph's Healthcare London, 268 Grosvenor Street, London, ON N6A 4V2 Canada
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Decuyper II, Rihs HP, Van Gasse AL, Elst J, De Puysseleyr L, Faber MA, Mertens C, Hagendorens MM, Sabato V, Bridts C, De Clerck L, Ebo DG. Cannabis allergy: what the clinician needs to know in 2019. Expert Rev Clin Immunol 2019; 15:599-606. [DOI: 10.1080/1744666x.2019.1600403] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ine Ilona Decuyper
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Hans-Peter Rihs
- IPA—Institute for Prevention and Occupational Medicine, German Social Accident Insurance, Ruhr-University Bochum, Bochum, Germany
| | - Athina Ludovica Van Gasse
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Jessy Elst
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Leander De Puysseleyr
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Margaretha Antje Faber
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Christel Mertens
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Margo Maria Hagendorens
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
- Department of Pediatrics, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Vito Sabato
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Chris Bridts
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Luc De Clerck
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Didier Gaston Ebo
- Department of Immunology-Allergology-Rheumatology, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
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Drouet M, Hoppe A, Moreau AS, Bonneau JC, Leclere JM, Le Sellin J. [Cannabis and crossed allergy with food]. REVUE DE PNEUMOLOGIE CLINIQUE 2017; 73:290-293. [PMID: 29122396 DOI: 10.1016/j.pneumo.2017.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/12/2017] [Accepted: 09/13/2017] [Indexed: 06/07/2023]
Abstract
Cannabis use has increased over the last decade. At the same time, we see cannabis allergies appearing, ranging from simple rhinoconjunctivitis to anaphylactic-type reactions, some of which are severe since fatal cases have been described, but we also see allergic-induced food allergies cross-linked in the family of lipid transfer proteins (LTP). Indeed, cannabis contains an LTP called Can s 3. The LT are very widespread in the vegetable kingdom and are present in many vegetables and fruits. LTPs have a similar chemical structure and therefore cross-allergy is common. Thus, by becoming aware of the LTP of cannabis, it is possible to become allergic by a mechanism of cross-allergy to the other LTPs present in fruits and vegetables. This syndrome is referred to as cannabis-fruit-vegetable syndrome.
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Affiliation(s)
- M Drouet
- Unité d'allergologie générale, département de pneumologie, oncologie thoracique et allergologie, CHU, 4, rue Larrey, 49933 Angers cedex 09, France.
| | - A Hoppe
- Unité d'allergologie générale, département de pneumologie, oncologie thoracique et allergologie, CHU, 4, rue Larrey, 49933 Angers cedex 09, France
| | - A S Moreau
- Unité d'allergologie générale, département de pneumologie, oncologie thoracique et allergologie, CHU, 4, rue Larrey, 49933 Angers cedex 09, France
| | - J C Bonneau
- Unité d'allergologie générale, département de pneumologie, oncologie thoracique et allergologie, CHU, 4, rue Larrey, 49933 Angers cedex 09, France
| | - J M Leclere
- Unité d'allergologie générale, département de pneumologie, oncologie thoracique et allergologie, CHU, 4, rue Larrey, 49933 Angers cedex 09, France
| | - J Le Sellin
- Unité d'allergologie générale, département de pneumologie, oncologie thoracique et allergologie, CHU, 4, rue Larrey, 49933 Angers cedex 09, France
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